How to Become a Medical Coder and Biller

Find out what it takes to become a medical coder and biller.

If you’re a wizard with numbers and have keen attention to detail, then you might have found your calling as a medical coder or biller.

A job as a medical coder or biller offers plenty of career advancement opportunities—you can work your way up to a medical records supervisor, clinical auditor, or clinical case manager position—and job security. The Bureau of Labor Statistics projects a 9% increase in all medical records specialist jobs over the next decade—including medical coder and biller jobs.

In this article, we’ll show you how to become a medical coder or biller and which path to take (e.g., high school, college, or certification) to get a job in medical coding and billing.

What Is Medical Coding?

Medical coding involves translating medical diagnoses, procedures, and treatments into alphanumeric codes (codes that contain letters, numbers, and special characters) for billing and insurance reimbursement. These codes are typically used by healthcare providers, insurance companies, and government agencies to keep track of healthcare costs and ensure that patients are billed correctly for procedures.

What Is Medical Billing and Coding?

The terms “medical billing” and “medical coding” are often used together, but they are two separate functions in medical administration. Some practices have one person who does both medical coding and billing while others have two separate—but intertwined—departments.

Medical billing involves preparing billing statements based on the medical codes and submitting them to insurance companies for reimbursement. They also track insurance payments and then bill the remaining amount to patients.

What Does a Medical Coder Do?

Medical coders analyze and interpret medical diagnoses and records and assign them the appropriate diagnostic and procedural codes. They typically work with coding systems such as:

  • The International Classification of Disease, 10th Revision (ICD-10): This is a global medical coding system designed by the World Health Organization (WHO) that’s used to classify medical diagnoses.
  • Current Procedural Terminology (CPT): This is a coding system maintained by the American Medical Association that is used for reporting medical procedures for billing. CPT codes contain five numeric digits, which are placed into three different categories:
    • Category I: Describes medical procedures and services.
    • Category II: Optional codes used for performance measurement and data collection.
    • Category III: Temporary codes used only for emerging procedures and technologies.

Other day-to-day tasks of medical coders include:

  • Identifying information that’s missing from medical records.
  • Auditing and validating clinical documentation and coded data.
  • Updating medical records with the appropriate codes and sending them to medical billers.
  • Training and mentoring other medical coding staff.
  • Communicating with insurance companies and healthcare providers to ensure that medical claims are accurate.
  • Updating medical data as needed.

What Does a Medical Biller Do?

While medical billers work in tandem with medical coders, they have different day-to-day tasks, including:

  • Creating invoices based on the medical codes assigned to patient care.
  • Submitting claims to insurance companies.
  • Billing patients for the remaining balance after an insurance payout.
  • Tracking and updating patient payments.
  • Confirming patient coverage with insurance companies.
  • Investigating outstanding patient invoices and denied claims.

Want to know more about what employers look for in candidates for medical coding jobs? See our medical coder job description sample.

Can Medical Coders Work From Home?

Unlike many other healthcare professionals, medical coders often have the option to work remotely. In fact, some companies will only hire remote medical coders either as employees or contractors.

According to the AACP Medical Coding and Billing Salary Survey, about 55% of medical records specialists with an AACP membership—including medical coders—work from home.

Most on-site medical coders work 40 hours per week and keep regular office hours. Many remote medical coders set their own hours, as long as they meet their required deadlines.

How to Become a Medical Coder

The two minimum medical coding requirements are a high school diploma (or equivalent) and a working knowledge of coding systems. Medical coders with a high school diploma or GED often start out in clerical positions (e.g., medical clerk or data entry clerk) before applying for entry-level medical coding jobs.

Taking high school courses in algebra, computer science, biology, and anatomy is a great way to get a head start on your medical coding career. However, most employers prefer candidates who have a postsecondary medical coder certificate or college degree in medical coding, healthcare administration, or a related field.

The most common medical coding certifications include:

How to Become a Medical Coder: Obtain the CPC Credential

Before you can take the CPC exam offered by the AAPC, you’ll need to complete anatomy, pathophysiology, and medical terminology courses. If you already work in healthcare, you may be exempt. Each of these courses can take two months to complete, but you’ll only have access to the course materials for three months.

Once you’ve met the CPC prerequisites, you’ll need to prepare for the exam. The AAPC offers a CPC exam preparation course, which takes four to eight months to complete. The CPC exam consists of 150 multiple choice questions on medical terminology, anatomy, surgical procedures, CPT, and IDC-10.

While you can take the exam as many times as you need to receive a passing score of 70%, you can only do so twice per year.

Lastly, you’ll need two years of on-the-job medical coding experience to receive the full CPC credential. You can gain this experience before or after you pass the exam. If you pass the exam without any medical coding experience, you’ll be classified as an apprentice (CPC-A).

Once you’ve gained the required experience and provide two letters of recommendation—one from your employer and the other from a previous employer or colleague—you’ll be eligible for the full CPC credential.

How to Become a Medical Coder: Obtain the CCS Credential

Want to learn how to become a medical coder quickly with no experience? The CCS credential is the way to go. While there are no prerequisites to take the CCS exam, the AHIMA recommends one of the following paths:

The CCS exam contains between 115 and 140 multiple-choice and multiple-response items that cover coding knowledge and skills, coding documentation, provider queries, and regulatory compliance. You’ll need a score of 300 to pass.

Medical Coding Skills

To be successful as a medical coder, you’ll also need these skills and qualities:

  • Knowledge of medical terminology.
  • Knowledge of HIPAA rules and regulations.
  • An understanding of physiology and anatomy.
  • Attention to detail.
  • Analytical and critical thinking skills.
  • Excellent communication skills.
  • Computer skills.

How Long Does It Take to Become a Medical Coder?

It takes about two to four years to become a medical coder, depending on which path you take. If you only have a high school diploma, you’ll need about two years of clerical or administrative experience under your belt before applying for an entry-level medical coder job.

If you’re taking the college route, it will generally take two years to complete an associate degree and four years to complete a bachelor’s degree. That depends on whether you attend college full- or part-time.

It can then take anywhere from a couple of months to more than two years to obtain a medical coding certificate.

What Is the Medical Coding Career Path?

After gaining experience in medical coding, you’ll have the opportunity to move up to advanced positions in medical records, such as:

  • Clinical auditor: Clinical auditors conduct audits of medical records, coding, and billing. They ensure that data, records, and billing invoices are complete, accurate, and compliant.
  • Medical records supervisor: Medical records supervisors supervise medical records specialists, provide training, and assign work to staff.
  • Medical coding supervisor: Medical coding supervisors supervise and train coding staff and ensure coding accuracy and compliance with applicable guidelines and regulations.
  • Health information management director: Health information management directors oversee the integrity, security, and privacy of clinical and financial information.

How to Become a Medical Biller

After learning how to become a medical coder, you may want to expand your skills and job options. Consider learning how to become a medical biller, which is among the most in-demand healthcare finance jobs.

First, complete coursework in medical terminology, anatomy, and pathophysiology unless you already have a relevant college degree or work experience. Then, get your Certified Professional Biller (CPB) credential from the AAPC.

You’ll need to complete 16 weeks of online medical billing training and score a 70% on the exam. The exam consists of 200 multiple-choice questions that cover insurance, billing regulations, HIPAA, reimbursement and collections, billing, coding, and case analysis.

How Much Do Medical Coders Make?

Medical coders typically earn between $24.98 and $39.29 per hour, while medical billers earn between $19.57 and $26.66. Your medical coding and billing salary will also depend on your location and experience level.

Want to find out what medical coding and billing salaries are in your area? Enter any job title and location into Monster’s Salary Tool to find the pay range for medical coding and billing in your city and a list of potential next steps along your medical coding career path.

How to Find Medical Coder and Biller Jobs

Once you’ve learned how to become a medical coder and biller, you’ll be ready to begin your job search. But first, you’ll need a medical coding or medical billing resume that highlights your knowledge of medical terminology, coding systems, medical records management, and medical billing. Plus, it should contain any medical coding or billing credentials you hold.

Applying for a medical coding job shouldn’t be a numbers game. If you want to boost your chances of getting an interview, you’ll need a cover letter that shows how your skills, medical coding credentials, and experience match the job. Our cover letter examples can show you how to make a great first impression when you apply.

Once your resume and cover letter are ready to go, it’s time to apply for medical coding and billing jobs.

Medical coders and billers are in high demand in these U.S. cities:

Set a Record in Your Medical Coding Career

Now that you understand how to become a medical coder, take the next step in your job search by creating your profile on Monster. We’ll keep you updated on new medical coding and billing jobs and get your resume in front of hiring managers in healthcare. Plus, we offer expert career advice tailored to your job search, including tips on finding a job, writing a resume, and preparing for an interview.